Trial Report Long-term health outcomes of Q-fever fatigue syndrome patients, 2023, Spronk

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Long-term health outcomes of Q-fever fatigue syndrome patients


Published online by Cambridge University Press: 19 September 2023

Inge Spronk,
Iris M. Brus,
Annemieke de Groot,
Peter Tieleman,
Alfons G. M. Olde Loohuis,
Juanita A. Haagsma and
Suzanne Polinder

Summary

This study determined long-term health outcomes (≥10 years) of Q-fever fatigue syndrome (QFS).

Long- term health complaints, health-related quality of life (HRQL), health status, energy level, fatigue, post exertional malaise, anxiety and depression were assessed.

Outcomes and determinants were studied for the total sample and compared among age subgroups: young (<40y), middle-aged (≥40-<65y), and older (≥65y) patients.

368 QFS patients were included.

Participants reported a median number of 12.0 long-term health complaints.

Their HRQL (median EQ-5D-5L index: 0.63) and health status (median EQ VAS: 50.0) were low, their level of fatigue was high, and many experienced post-exertional malaise complaints (98.9%).

Young and middle-aged patients reported worse health outcomes compared to older patients, with both groups reporting a significantly worse health status, higher fatigue levels and anxiety, and more post-exertional malaise complaints; and middle-aged patients having a lower HRQL and a higher risk of depression.

Multivariate regression analyses confirmed that older age is associated with better outcomes, except for the number of health complaints.

QFS has thus a considerable impact on patients’ health more than 10 years after infection.

Young and middle-aged patients experience more long-term health consequences compared to older patients.

Tailored healthcare is recommended to provide optimal care for each QFS patient.

 

"Post exertional malaise (PEM) in the previous days was assessed using the five items for post exertional neuroimmune exhaustion [18]. Patients scored items on a 5-point Likert scale ranging from 1 (‘yes, that is true’) to 5 (‘no, that is not true’). "

Which would mean they asked about
1. Marked, rapid physical and/or cognitive fatigability in response to exertion, which may be minimal such as activities of daily living or simple mental tasks, can be debilitating and cause a relapse.
2. Postexertional symptom exacerbation: e.g.acute flu-like symptoms, pain and worsening of other symptoms.
3. Postexertional exhaustion may occur immediately after activity or be delayed by hours or days.
4. Recovery period is prolonged, usually taking 24 h or longer. A relapse can last days, weeks or longer.
5. Low threshold of physical and mental fatigability (lack of stamina) results in a substantial reduction in pre-illness activity level.

 

"Post exertional malaise complaints were common in QFS patients; all (98.9%) except four patients reported at least mild complaints at one of the five post exertional malaise domains. Almost all patients reported at least mild complaints (95.6 – 97.8%) on four of the post exertional malaise domains, and many also reported at least mild post exertional symptom exacerbation (88.6%) (Figure 4). Older patients reported statistically significant less post exertional malaise complaints (Figure 5; p<0.001 – p=0.032), except for the domain ‘low threshold of physical and mental fatigability’; for which patients in all subgroups reported many problems (96.7 – 100%). No significant differences were found between the younger and middle-aged patient groups."